Health

An essential component of health systems change is the collaboration and coordination needed to truly operate as a joined-up system. This requires effective mechanisms through which health system actors can communicate and collaborate differently, finding a shared understanding and common goals to unite their efforts around. 100-Day Challenges offer an intensive glimpse into what can be achieved when primary care, hospitals, the voluntary sector, ambulances services, and non-traditional actors unite to own and drive change. 

• In the United Arab Emirates, teams found that sharing data between the Ministry of Community Development, Ministry of Health and other organizations helped them identify many more patients eligible for breast cancer screenings, thereby detecting cases much earlier and saving lives.
   
• In Ethiopia, HIV/AIDS detection was turbocharged when private sector companies were engaged in voluntary testing and counseling services. Half of the participating companies were able to extend voluntary testing and counseling services to 75-95% of their staff in less than 100 days.

To truly offer integrated care services to patients and the community, health systems across the world must identify what they are trying to achieve and acknowledge that they can only achieve it together. 

We have found that the most common lasting legacy of health 100-Day Challenges is the collaboration mechanisms the methodology leaves behind - the glimpse systems gain in 100 days of what is possible when working together leaves little choice but to grow and cement that integration for the long term. 

Another common thread running through any 100-Day Challenge is the reframing of service delivery from the point of view of what patients need to access good quality health services. Patients play active roles on 100-Day Challenge teams. Our system mapping exercises are built through the patient experience of health services. We suddenly find that to achieve the outcomes we set out, we must do active patient outreach.
In every system we have implemented health 100-Day Challenges in, we have found that teams, in order to achieve their goal, must reach out to their communities. Proactively looking for and listening to those whose work is meant to benefit.

• In Eritrea, commercial sex workers played an essential part in the fight against HIV/AIDS, working with the Ministry of Health to promote and practice safe sex and successfully reduce infection rates. They even went on to lead 100-Day Challenges on behalf of the Ministry.
   
• In Harrogate, in the north of England, teams tested approaches to reduce the burden of elective care on hospitals, a patient advocate supported the team in designing community physiotherapy classes that helped prevent patients from needing costly further hospital visits. 

Time and time again, the benefits of the system of putting the patient at the center of transformation design become clear, no matter the 100-Day Challenge or where it is being implemented: treatment costs are reduced when breast cancer is detected earlier, surgeon time is saved when we work with patients to design their follow-up care, lives are saved when pregnant women trust the ante-natal care they are offered.

There is no doubt that trying to deliver transformation in health systems means an inevitable grappling with complexity. Health coverage, health financing, service delivery, prevention, the links between social and healthcare, spiraling costs - everything is connected, and none of it is easy to ‘solve’. The complexity of trying to make improvements in healthcare settings often prevents systems from even starting. 100-Day Challenges can serve as a way to show that change is possible and build the belief that results can be achieved.

• Despite overwhelming national maternal and neonatal mortality rates and the COVID-19 pandemic, one team in Sierra Leone managed to deliver a reduction in stillbirth rates from 12.7% to 5% through testing several innovations in the community.
   
• In Nepal, all pregnant women within 100-Day Challenge communities eat one egg and two servings of green vegetables a day - a small but significant step in supporting healthy child growth (and healthy mothers).

100-Day Challenges can be used to ‘shrink the change’ we are trying to achieve, to break it up into more manageable chunks. By focusing on specific and measurable results in a short period of time, multi-disciplinary teams can test models before large scale investment is made, they can experiment with new ways of delivering services, and leaders can gain insight into the true obstacles to larger-scale change might be. 

Ultimately, RE!NSTITUTE’s work in health has the same objective no matter the 100-Day Challenge goal, no matter the community, no matter the system - to support all human beings to lead healthier lives. To support systems to bravely and radically RE!THINK the way they tackle complex challenges and show us all it’s possible to transform the lives of our essential workers as well as the patients they care for.